Is it Breast Augmentation or Breast Reconstruction?

Q:

I have double lumen Dow Corning Silicone implants with a dwell life of 35 yrs. The implants caused major degenerative anatomic changes to my upper chest. Removal of implants & scavenging of the tissue was mandatory to interrupt the necrotic processes. To correct the resultant significant deformity, I needed larger prosthesis because of the tremendous loss of diseased tissue. Is re-insertion of new implants considered cosmetic or reconstructive?

A:

It is impossible to answer your question regarding whether replacing your breast implants is considered cosmetic or reconstructive, as you have not provided enough information. If you had a mastectomy and reconstruction for cancer or precancerous conditions as the initial procedure where you received the implants, then, generally, anything else done to replace these implants or correct problems from them is considered reconstructive. However, if you had the implants placed for cosmetic purposes to enlarge the breasts, then most insurance carriers considers anything that happened a result of that cosmetic procedure and do not pay for revision. Even then, some carriers may cover significant problems as a result of the implants. Also, since you had Dow Corning implants, there was, quite a number of years ago, now a settlement for them. The only way to determine whether or not the surgery in your case is considered reconstructive is to provide all the information about why the implants were placed previously and the present problem to your insurance carrier and ask if the surgery would be covered.

A:

Laura Mary,

Revision of a cosmetic breast augmentation often is not covered by medical insurance.

However in your case it may be possible. The best option would be to ask your plastic surgeon his or her opinion as to whether you can obtain insurance coverage. It will be necessary for the surgeon to submit a request to your insurance company for determination whether coverage is available or not.